Narratives on the Current Medical Situation in Japan According to Highly Specialized Foreign Professionals.

In order to understand the difficulties faced by highly skilled foreign professionals when dealing with the Japanese healthcare system and to identify the support they require therein, university health center staff members of the Okinawa Institute of Science and Technology Graduate University conducted semi-structured interviews with faculty, staff, and students from the Institute. Data from the interviews were analyzed by subject matter analysis using a narrative-oriented approach. In total, 13 participants were interviewed, and five themes and 15 subthemes were generated from the 40 codes extracted. Although participants considered themselves to be accepting of other cultures and made little mention of the need for cultural and religious considerations that previous studies have identified as important, they reported that their experiences receiving healthcare in Japan were fraught with many difficulties. They felt that the capacity to communicate in Japanese was a prerequisite for receiving appropriate healthcare and that hospitals should assume the responsibility of providing language support. While they reported satisfaction with the easy and inexpensive access to advanced medical equipment and specialists in Japan, they also noted challenges in selecting medical institutions and departments, the flow and procedures in the hospital, and building open and direct relationships with doctors. In addition, based on the present study, people with chronic illnesses felt isolated from the community, worried about a lack of privacy, and wanted a primary care physician they could trust. In order to provide appropriate healthcare to foreigners, we require an accurate understanding of their needs, how to address these comprehensively and in a multifaceted manner, and how the communication responsibilities should be shared among the involved parties (i.e., foreign care recipients and Japanese medical professionals).

The Importance of "Easy Japanese": Communicating Health Information to Foreigners in Japan.

The number of foreign workers in Japan has been increasing in recent years. In Shimane Prefecture, people from non-English speaking countries account for most of the foreign resident population. Language barriers pose numerous challenges for this population. Their problems communicating in the medical context, in particular, contribute to their avoidance of hospitals. In addition to translation machines and English, "Easy Japanese" has been found to help Japanese healthcare workers communicate with foreign patients. "Easy Japanese" refers to easy-to-understand Japanese that involves rephrasing words and sentences. The use of Easy Japanese should be promoted among medical professionals in Japan as it is considered a communication skill that can be improved through practice. A voluntary study group was formed among medical students. During the first session, students were presented with background information, explaining why the need for Easy Japanese is increasing. In the second session, they practiced paraphrasing words. Finally, in the third session, they conducted simulated medical communication and practiced Easy Japanese with foreign residents to determine whether they were able to convey their intentions. Participants were recruited via social networking service, with five participants in the first session, five in the second, and eight in the third. Through this project, it became clear that for participants, the usual way of speaking Japanese came first in practice and that it was difficult for them to produce easy-to-understand phrases at the spur of the moment without practice. Additionally, medical students reported that the expressions they acquired through several practice sessions were helpful when talking with international students on campus. The final session involved a student-led Easy Japanese study group. Based on the students' comments, we found that this study group was useful for them. Accordingly, Easy Japanese education should be continued and expanded to more students in the medical field and to the local community, including foreign residents, to measure its effectiveness.

[Demographic Characteristics of Foreign Residents in Japan; Child Maltreatment and Language Problems in Child Protection Services].

In this study, we examined the changes in the demographic characteristics of foreign residents in Japan (FRJ) and the current status of FRJ from a global health perspective. We also considered child maltreatment that occurred in FRJ families and language problems in child welfare. Japan's official statistics in the end of 2017 indicated that there were more than 2.56 million FRJ from over 190 countries. This population was diverse with heterogeneous characteristics, such as age structure, dwelling place, marital status, and childbirth. At the end of 2017, there were 219,982 FRJ children aged 0-14 of various nationalities, including Chinese, Brazilian, South Korean, North Korean, Filipino, Vietnamese, Peruvian, Nepalese, and Indian. In 2010, we conducted our first survey of child maltreatment in FRJ families, targeting 219 child protection centers across Japan. Between April 2007 and August 2010, 1,639 child maltreatment cases were reported from 56% of these centers. Details of 1,111 cases were collected and descriptive analyses were conducted. The male-to-female ratio was 0.88 and the median age was 8 years: however, the age distribution showed that females were significantly older than males (P < 0.01). The proportions of physical abuse, child neglect, emotional abuse, and sexual abuse were 38%, 33%, 21%, and 7%, respectively. Native language problems created numerous challenges and required a large amount of effort from child welfare practitioners. However, most solutions to identified problems were still at the beginning stage and some were found to be ineffective. More interdisciplinary and integrated researches are needed targeting child welfare of FRJ. An ethical framework for good counseling practices should be developed.

Interest in medical health care for foreign residents among Japanese nursing students in areas of varying ethnic diversity.

BACKGROUND: Exposure of nursing students to foreign residents may improve cultural understanding. Nursing students are expected to have differing rates of contact with foreign residents, depending on how many foreign residents live in their municipality where they study in. Those in areas densely populated by foreign residents are more likely to encounter foreigners, and to have favorable views of them than students in areas with sparser foreign-resident populations. As of 2015, 2.23 million foreign residents lived in Japan, equaling 1.76% of the population; however, Japan still has fewer foreign-born residents compared to other countries. Therefore, interest in Medical Health Care for Foreign Residents (MHCFR) may be greater in students in ethnically diverse areas. While nursing students may have different levels of recognition of foreign nationals as potential clients and interest in MHCFR, no research validates this assumption. OBJECTIVES: This study aimed to clarify the association between proximity to foreign nationals and interest in MHCFR among Japanese nursing students. The secondary purpose was to describe knowledge and interest regarding MHCFR among students. To elucidate these topics, education and development of human resources in MHCFR should be considered. RESEARCH DESIGN AND METHOD: The study design was cross-sectional. A self-administered questionnaire survey was conducted with 143 nursing students. RESULTS: Most students understood the likelihood of providing nursing care to foreigners; however, knowledge and interest were low, regardless of whether lectures on MHCFR were provided. Knowledge of MHCFR, recognition of providing care to foreign nationals, and level of contact experiences with foreign nationals were significantly associated with students' level of interest in MHCFR. DISCUSSION: Nursing students in ethnically diverse areas tend to show greater interest in MHCFR in Japan. To foster global health perspectives, including MHCFR, in nursing students studying in ethnically diverse areas, contact experiences with foreigners and acceptance of international students by universities might be effective.

An investigation of potential demand for acupuncture and moxibustion from the medical information center for foreign residents in Japan / 全日本鍼灸学会雑誌

[Introduction]The number of foreign residents in Japan reached 1.7%of the national population at the end of 2010, and currently the number of foreign permanent residents is increasing. Althogh this “domestic globalization”has been in progress for some time, the health status and needs of foreign residents for acupuncture treatment are not known to acupuncture practitioners in Japan. The purpose of this study is to reveal the proportion of potential demand for acupuncture by examining the consultation records for medical informations from foreigners living in Japan.<BR>[Method]From all the records of telephone consultation for medical information by foreign residents from all over the country to AMDA International Medical Information Center in 2010, we extracted the consultations associated with acupuncture.<BR>[Results]Among a total of 2,172 consultations, 6calls were associated with acupuncture (0.3%). Most of the foreign residents who made these consultations were from South America. 4calls were requests for information about acupuncture clinics from foreigners suffering from orthopedic disease or symptoms (66.7%). With respect to the consultion languages, 4consulters accepted inquiries in Japanese (66.7%).<BR>[Discussion]Foreign residents who expect acupuncture treatment are not common, but it became obvious that some foreigners have difficulty finding acupuncture clinics and information in Japan. There were some cases that should have been applicable to acupuncture, but were instead directed to other diagnosis departments or hospitals. One reason for this consequence seems to be the lack of information among foreign residents about the indications and therapeutic effects of acupuncture. Considering the influx of foreigners and the aging of foreign residents, the possibility of foreigners reciving acupuncture treatment may be developed by appropriate distribution of information.

A Survey of the Awareness and Ability of Health Care Providers to Cope with Language Barriers at Medical Facilities in Hyogo, Japan / 国際保健医療

<B>OBJECTIVE:</B><br>This study aims to examine the awareness and ability of health care providers to cope with language barriers at medical facilities in Hyogo Prefecture, Japan, and to clarify the issues concerning health care for foreigners.<br><B>METHODS:</B><br>In total, 2100 copies of self-report questionnaires on issues of health care for foreigners were mailed to health care providers of 352 hospitals in Hyogo. The survey was conducted from February to March 2010.<br><B>RESULTS:</B><br>The response rate of medical facilities was 21.6% (76/352), whereas that of the health care providers was 15.2% (320/2100). Approximately 10% hospitals handled foreign patients at least once per month, and they dealt with patients using several languages, including English, Chinese, Korean, and others. The providers' main issue was communication with their foreign patients. The documents and booklets for guidance regarding some health care procedures at the hospitals were also poorly prepared. It is therefore exceedingly necessary for hospitals to provide common documents in different languages; moreover, the government or local authorities should arrange for public medical interpretation services.<br><B>DISCUSSION:</B><br>Medical facilities in Hyogo have been struggling to improve their linguistic capabilities, and it is difficult to indicate whether public organizations concerned with medical interpretation are being recognized. Efforts on the part of medical facilities and local and national governments, as well as cooperation of nonprofit organizations, are immensely essential to resolve the issue of multilingual health care. This survey suggests that to help people with diverse languages, the health care system in Japan should be improved rapidly, particularly with regard to the establishment of licensed professional medical interpreters.

Japanese Nurses' Views of Perioperative Management of Foreign Patients in Osaka / 国際保健医療

Objectives: To examine perceptions of nursing care for foreign patients in the ward and operating room (OR) and to clarify incidents and difficulties in nursing care.<br>Methods: Fifty-five obstetric and gynecological ward nurses and 13 OR nurses were contacted in writing and asked to participate in a self-administered questionnaire to clarify their perceptions of nursing care for foreign patients.<br>Results: The response rates for ward nurses and OR nurses were 65% (n=36) and 77% (n=10) respectively. One hundred percent of nurses with experience of foreign patient care stated that they had difficulties with language, cultural differences, the medical system, and financial problems. Incidents resulting from the nursing care included: not following instructions not to take food/drink, walking too soon, and missing their clinical follow-up appointment after discharge.<br>Conclusions: This research showed major difficulties with perioperative nursing care for foreign patients. These difficulties may have occurred as a result of issues such as language, differences in culture and the health care system. Difficulty with nursing care for foreign patients sometimes causes incidents. It is recommended that the barriers between non-Japanese patients and the medical staff are rectified in the perioperative period, when mutual understanding is important.

A needs survey of medical service for foreign residents in Japan from the viewpoint of medical practitioners-Report of a survey for doctors in Gunma medical association and Gunma pediatric association- / 国際保健医療

<B>Introduction</B><BR>Recently, an increasing number of registered foreigners get married and bear children in Japan. At the same time, a variety of needs for maternal and child health (MCH) impose burden for medical practitioners. A questionnaire survey was conducted to clarify the situation of MCH service for foreign residents.<BR><B>Method</B><BR>Self-report questionnaires developed by “The study group for MCH in a multiethnic and multicultural society” were sent by mail to the pediatricians registered in the Gunma medical association or Gunma pediatric association. In total, target number was 299. The survey period was between 2003/10/6-11/3.<BR><B>Result</B><BR>The number of valid response was 167. Out of 167, 155 doctors replied to have experience of caring foreigners. 75% of them had the experience of trouble in communication. For the question of the need of translator, 76.8% of doctors answered “absolutely necessary” or “necessary if the quality of translation is high enough”. Desired competencies for translators were “Accurate translation of diagnosis, hands on of treatment strategy” or “To help taking detailed patient's history”.<BR>For the experience of using MCH handbook in foreign languages, 52.9% of doctors answered “Never used it”.<BR><B>Discussion</B><BR>We found that the majority of doctors had difficulty in communicating with foreigners.<BR>To meet the doctors' requirement for the competency of translator, two strategies should be considered. One is to develop professional medical translator through education of basic medical knowledge or Japan's health care system. The other is to train foreigners already engaging in translation.<BR>For communication tools development, user friendly concept should be reflected including 1) adscript of foreign and Japanese languages, 2) illustration usage and 3) eye-friendly materials for elderly. Contents should have explanations including 1) diagnosis and treatment policy for common disease, 2) ways of coping with common symptoms, and 3) the information of a variety of Japan's welfare services.

The process of building relationships between foreign patients and nurses in Japan / 国際保健医療

 The purpose of this inductive study was to clarify the process of building relationships between foreign patients, who are residents in Japan, with diverse cultural backgrounds and nurses who have cared for hospitalized foreign patients within the past year. Data collection was conducted through semi-structured interviews of eleven Japanese nurses. Analysis of data used the grounded theory methodology. <br> The results of the analysis revealed the following core components of the relationship building process: [Intention to provide appropriate nursing care for foreign patients], [Intention to understand foreign patients’ diverse backgrounds from the perspective of one’s own culture], [Indecision regarding relationships with foreign patients], and [Compromises between nurses and foreign patients]. Furthermore, 25 categories and 110 subcategories of these components were identified.<br> The most important feature of the process of building relationships between foreign patients and nurses was that nurses requested that foreign patients have the same role as Japanese patients<br> Subsequently, the nurses became aware of the differences between their own culture and foreign patients’ diverse cultural backgrounds. Consequently, the nurses had made progress in increasing their awareness of cultural differences.<br> The present results suggest the importance of facilitating Japanese nurses’ recognition of the existence of cultural difference, and improving the process of compromising with accepted cultural difference.

Health and Community of the Foreign Residents / 国際保健医療

 Kani city, Gifu is yet a typical small local town of 100,000 populations but has Japanese Brazilian and Filipino increased recently and shares 7% of total population that is a foreigner residing town.<br> The foreigner residing towns to be called are facing similar several issues at every place. The working and educational environment for the people as the migrant worker from Central and South America and their health condition which is the most important became worsen.<br> 4 years ago in Kani city, we made a survey for the educational environment of the children of foreigners for 2 years period, which was reported in public and gained favorable evaluation from several sectors.<br> Nowadays we are promoting to assure their social status who live in the local community. They are working as same as Japanese, and sometime to do the job that Japanese would not, but it seems that they are ignored on their treatment in the social life. If they spoil their own health, their life planning may cause a serious problem. Once they dropout, they may not have any chance to recover themselves. This means the “healthy condition” of the local society will be damaged before long. Therefore, we started the foreign nationality citizen's committee where we can maintain not only the individual health but also to be healthy local society from the concept that the foreign residents would not rely on the local society but they act themselves as the citizen and the local residents to participate with the local activities so that they can enjoy their independency, health, pleasure and hope.